Anticoagulation therapy in COVID-19 patients with chronic kidney disease

Shafiee, Mohammad; Hosseini, Sayyideh Forough; Mortazavi, Mojgan; Emami, Anahita; Zadeh, Mahtab Mojtahed; Moradi, Sanaz; Shaker, Pouyan

doi:10.4103/jrms.jrms_875_20

Cited by 8 publications

(10 citation statements)

References 30 publications

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“… 37 Presentations range from arterial thrombosis and VTE (especially pulmonary embolism), renovascular thrombosis, disseminated intravascular coagulopathy, and end‐organ failure. 37 The incidence of VTE may be as high as 36% in intensive care unit (ICU) patients. 38 In addition, the coagulopathy and overall mortality in COVID‐19 patients with CKD may be worsened by their pre‐existing cardiovascular co‐morbidities and advanced age.…”

Section: Hospitalization Periodmentioning

confidence: 99%

“…Last, acute kidney injury (AKI) may be seen in as many as 19% and up to 63% of hospitalized COVID‐19 patients and is associated with an over 3‐fold increased risk of death, in addition to other adverse outcomes. 37 , 39 Although there is insufficient evidence to suggest specific anticoagulant strategies in COVID‐19 patients with CKD or AKI, both observational studies and clinical trials support the use of standard prophylactic doses of LMWH (e.g., enoxaparin 40 mg subcutaneously daily) or UFH (5000 IU subcutaneously twice or thrice daily) down to a CrCl of 30 ml/min. In non–critically ill COVID‐19 patients that meet criteria for therapeutic‐dose heparin, therapeutic doses of LMWH (e.g., enoxaparin 1 mg/kg subcutaneously twice daily) may be the preferred agent down to a CrCl of 30 ml/min.…”

Section: Hospitalization Periodmentioning

confidence: 99%

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Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Spyropoulos

Connors

Douketis

et al. 2022

Journal of Thrombosis and Haemostasis

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Despite the emergence of high quality randomized trial data with the use of antithrombotic agents to reduce the risk of thromboembolism, end‐organ failure, and possibly mortality in patients with coronavirus disease 2019 (COVID‐19), questions still remain as to optimal patient selection for these strategies, the use of antithrombotics in outpatient settings and in‐hospital settings (including critical care units), thromboprophylaxis in special patient populations, and the management of acute thrombosis in hospitalized COVID‐19 patients. In October 2021, the International Society on Thrombosis and Haemostasis (ISTH) formed a multidisciplinary and international panel of content experts, two patient representatives, and a methodologist to develop recommendations on treatment with anticoagulants and antiplatelet agents for COVID‐19 patients. The ISTH Guideline panel discussed additional topics to be well suited to a non‐Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for Good Practice Statements (GPS) to support good clinical care in the antithrombotic management of COVID‐19 patients in various clinical settings. The GPS panel agreed on 17 GPS: 3 in the outpatient (pre‐hospital) setting, 12 in the hospital setting both in non‐critical care (ward) as well as intensive care unit settings, and 2 in the immediate post‐hospital discharge setting based on limited evidence or expert opinion that supports net clinical benefit in enacting the statements provided. The antithrombotic therapies discussed in these GPS should be available in low‐ and middle‐income countries.

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Section: Hospitalization Periodmentioning

confidence: 99%

Section: Hospitalization Periodmentioning

confidence: 99%

Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Spyropoulos

Connors

Douketis

et al. 2022

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…However, both decreased and elevated D dimer values can lead the doctor to misdiagnose. Elevated D-dimer values are also found in patients with inflammatory processes, who suffer from chronic renal failure, cancer during pregnancy, injuries, surgeries [20,21]. Patients with elevated Ddimer levels due to its low positive predictive value should undergo further diagnostic testing to confirm and/or rule out the diagnosis of PE.…”

Section: Diagnostic Doubts and Missed Diagnoses Of Vtementioning

confidence: 99%

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Lasica¹,

Ašanin²,

Djukanovic³

et al. 2022

Preprint

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Pulmonary thromboembolism is a very common cardiovascular disease, with a still high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. Heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decision on the therapeutic regimen also represents a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate-high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug-drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only the effectiveness of the drugs must be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.

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“…2 ). Among individuals infected with SARS-COV-2, those with pre-existing CKD are more likely to develop COVID-19-induced AKI than those without CKD [ 29 ] (Fig. 2 ).…”

mentioning

confidence: 99%

“…2 ). In addition, suppressing the cytokine storm may also be useful, since this would ameliorate the progression of generalized thrombotic microangiopathy that causes AKI [ 27 , 29 ]. In our series of patch-clamp studies, we have revealed the inhibitory properties of nonsteroidal anti-inflammatory drugs (NSAIDs), anti-hypertensive drugs, anti-cholesterol drugs and anti-allergic drugs on lymphocytes Kv1.3-channels [ 33 – 35 ].…”

mentioning

confidence: 99%

Targeting ACE2 as a potential prophylactic strategy against COVID-19-induced exacerbation of chronic kidney disease

Kazama

2022

Inflamm. Res.

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Patients with chronic kidney disease (CKD) are at higher risk for severe coronavirus disease 2019 (COVID-19). Such patients are more likely to develop “COVID-19-induced acute kidney injury (AKI)”, which exacerbates the pre-existing CKD and increases the mortality rate of the patients. COVID-19-induced AKI is pathologically characterized by acute tubular necrosis and the interstitial infiltration of proinflammatory leukocytes. In our rat model with advanced CKD, immunohistochemistry for angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) demonstrated their strong expression in the cytoplasm of damaged proximal tubular cells and the infiltrating leukocytes within the cortical interstitium, which overlapped with the lesions of COVID-19-induced AKI. Since ACE2 and TMPRSS2 are enzymes that facilitate the viral entry into the cells and trigger the onset of cytokine storm, the renal distribution of these proteins in advanced CKD was thought to be responsible for the development of COVID-19-induced AKI. Concerning such mechanisms, the pharmacological blockade of ACE2 or the use of soluble forms of the ACE2 protein may halt the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host cells. This would protect against the COVID-19-induced exacerbation of pre-existing CKD by preventing the development of AKI.

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Anticoagulation therapy in COVID-19 patients with chronic kidney disease

Cited by 8 publications

References 30 publications

Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Targeting ACE2 as a potential prophylactic strategy against COVID-19-induced exacerbation of chronic kidney disease

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